dc.contributor.author |
Srinivasa, Sanket |
en |
dc.contributor.author |
Kahokehr, AA |
en |
dc.contributor.author |
Yu, Tzu-Chieh |
en |
dc.contributor.author |
Hill, Andrew |
en |
dc.coverage.spatial |
United States |
en |
dc.date.accessioned |
2012-03-21T00:21:29Z |
en |
dc.date.issued |
2011-08-01 |
en |
dc.identifier.citation |
Annals of Surgery 254(2):183-191 01 Aug 2011 |
en |
dc.identifier.issn |
0003-4932 |
en |
dc.identifier.uri |
http://hdl.handle.net/2292/14840 |
en |
dc.description.abstract |
Objective: To determine the clinical safety and efficacy of preoperative glucocorticoid (GC) administration in major abdominal surgery with regards to short term outcomes. Background: Previous randomized controlled trials (RCTs) in major abdominal surgery have displayed conflicting results regarding the short-term benefits of preoperative GC administration. Importantly, the safety of this intervention has not been conclusively determined. Methods: A systematic review and quantitative meta-analysis was conducted of all RCTs exploring preoperative GC administration in major abdominal surgery for the endpoints of complications, hospital length of stay (LOS) and serum IL-6 on postoperative day one. Subset analyses by procedure were planned “a priori.” Results: Eleven RCTs of moderate quality, comprising 439 patients in total, were included in the final analysis. Preoperative GC use decreased complications (OR = 0.37; 95% CI, 0.21–0.64; P < 0.01), LOS (mean = 1.97 days; 95% CI, -3.33 to -0.61; P = 0.01), and serum IL-6 (mean: -55 pg/mL; 95% CI, -82.30 to -27.91; P < 0.01). Preoperative GCs decreased complications in hepatic resection (OR = 0.28; 95% CI, 0.14–0.55; P < 0.01) and mean LOS (mean LOS: -2.66; 95% CI, -5.01 to -0.32; P = 0.03). GCs reduced mean LOS in patients undergoing colorectal surgery (mean LOS: -0.98; 95% CI, -1.67 to -0.27; P = 0.01). There was no difference in complication rates (OR: 0.45; 95% CI, 0.16–1.32; P = 0.15) or anastomotic leaks specifically. Conclusions: Preoperative administration of GCs decreases complications and LOS after major abdominal surgery as a likely consequence of attenuating the postsurgical inflammatory response. There is no evidence of increased complications in colorectal surgery. |
en |
dc.language |
English |
en |
dc.publisher |
Lippincott, Williams & Wilkins |
en |
dc.relation.ispartofseries |
Annals of Surgery |
en |
dc.rights |
Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. |
en |
dc.rights.uri |
https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm |
en |
dc.subject |
Science & Technology |
en |
dc.subject |
Life Sciences & Biomedicine |
en |
dc.subject |
Surgery |
en |
dc.subject |
HIGH-DOSE METHYLPREDNISOLONE |
en |
dc.subject |
CARDIAC-SURGERY |
en |
dc.subject |
METABOLIC-RESPONSE |
en |
dc.subject |
HEPATIC RESECTION |
en |
dc.subject |
PERITONEAL INFLAMMATION |
en |
dc.subject |
SURGICAL COMPLICATIONS |
en |
dc.subject |
POSTOPERATIVE RECOVERY |
en |
dc.subject |
LIVER-TRANSPLANTATION |
en |
dc.subject |
ADRENAL INSUFFICIENCY |
en |
dc.subject |
COLORECTAL SURGERY |
en |
dc.title |
Preoperative Glucocorticoid Use in Major Abdominal Surgery Systematic Review and Meta-Analysis of Randomized Trials |
en |
dc.type |
Journal Article |
en |
dc.identifier.doi |
10.1097/SLA.0b013e3182261118 |
en |
pubs.issue |
2 |
en |
pubs.begin-page |
183 |
en |
pubs.volume |
254 |
en |
dc.rights.holder |
Copyright: Lippincott, Williams & Wilkins |
en |
dc.identifier.pmid |
21694581 |
en |
pubs.author-url |
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000292908700001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=6e41486220adb198d0efde5a3b153e7d |
en |
pubs.end-page |
191 |
en |
dc.rights.accessrights |
http://purl.org/eprint/accessRights/RestrictedAccess |
en |
pubs.subtype |
Article |
en |
pubs.elements-id |
217368 |
en |
pubs.org-id |
Medical and Health Sciences |
en |
pubs.org-id |
School of Medicine |
en |
pubs.org-id |
South Auckland clinical school |
en |
dc.identifier.eissn |
1528-1140 |
en |
pubs.record-created-at-source-date |
2012-08-22 |
en |
pubs.dimensions-id |
21694581 |
en |